Home Health: Recent Updates and Reminders

May 29, 2013

F.O.R.C.E. Healthcare Resources, LLC(Founded on Regulatory Compliance and Ethics)

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About F.O.R.C.E.?• Home Health Consulting Firm – Founded 2005

Services Provided:

1. Home Health Billing Webinars

2. Home Health Outsource Billing

3. Home Health Outsource Medical Coding

4. Home Health Billing Clean-up/Recovery Projects

5. Home Health Operation / Process Consulting

6. Home Health Financial Consulting

Contact InformationF.O.R.C.E Healthcare Resource, LLC.

– Website: www.forcehealthcare.com• Terri Ready, COO

- Direct: 423-643-2256 ext. 104- Mobile: 423-593-1627- tready@forcehealthcare.com

• Lynn Alley, Office Manager– Direct: 423-643-2256 ext. 107– lalley@forcehealthcare.com

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PECOS requirement is still delayed!

CMS will advise you of the new implementation date in the near future. In the interim, informational edits will continue to be sent for those claims that would have been denied had the edits been in place.

Mandatory Payment Reductions in the Medicare Fee-for-Service (FFS) Program 'Sequestration. In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a two percent reduction in final Medicare payment.

The 2% reduction will appear on the Medicare paper remit in location “Pre Payment Adjustment”. On the ERA it appears in the “CARC” location.

PAYMENT REDUCTIONS

(SEQUESTRATION)

How to Identify and Document Point of Service Codes (Q codes)

Effective for HH episodes beginning on or after July 1, 2013, HHA’s are to use the HCPCS codes Q5001, Q5002, and Q5009 on home health claims to report where home health services were provided. The following table lists the definitions of the Q-codes which were revised effective April 1, 2013:

HCPCS Code Definition

Q5001 Hospice or home health care provided in patient's home/residence

Q5002 Hospice or home health care provided in assisted living facility

Q5009 Hospice or home health care provided in place not otherwise specified (NO)

How to Identify and Document Point of Service Codes (Q codes)

• Point of service must be documented so the billing staff can add the appropriate Q code to claims.

• Gather this information upon the start of care (SOC) and recertification visits.

• Document the point of service in a designated location that is made known to the billing staff.

• Ask your software company if they have/will be adding a locator in their system to accommodate this coding principle.

(HETS) HIPAA Eligibility Transaction System

• CMS intends to terminate access to the other CWF eligibility queries implemented in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE), often referred to the HIQA, HIQH, ELGA and ELGH screens and HUQA in 2014. This will not affect the use of DDE to submit claims or to correct claims. The CWF will be replaced by HETS.

Home Health Request for Anticipated Payment (RAP) Suppression

• Intermediaries are monitoring the number of RAPs that are auto-cancelled due to providers not filing a final claim. In accordance with Medicare regulations, contractors have the authority to revoke a provider’s privilege to receive payment on the RAP. Therefore, providers identified with a high number of RAP auto-cancels due to no final claim will be notified (by letter) that their RAPs will be set to pay at zero percent.

• If an agency believes they were timely in filing final claims, or has a rationale for the number of cancelled RAPs, they can send a rebuttal to the fax number listed in the letter. In the rebuttal they can identify the reason(s) the RAPs cancelled and the number of RAPs affected.

Copays for Home HealthPresident Obama has proposed for the 2014 budget copays and rate reductions in the form of bundled payments. Both concepts have been endorsed by the Medicare Payment Advisory Commission.

Home Health and Hospice CodingAccurate and timely coding is essential to the success of every Home Health Agency. Many of our clients have already realized the benefits of having a partner that is dedicated to maintaining the highest standards in ICD-9CM coding. Our coding staff code with high regard to Medicare regulations at the same time keeping in mind the structure for the best reimbursement. I would like to share a few examples of how we have been able to assist some of our clients with their coding needs.1. A large Hospice agency with urban and rural branches were unable to recruit talent

for the rural location; we were able to quickly and easily fill that need. We made 1 code change on an episode for the urban branch and was able to increase the reimbursement by $700.

2. An agency in Kentucky was four months behind and FORCE was able to catch them up in one month generating a half a million dollars. Their sister company then requested the same service.

Home Health and Hospice Coding

3. We had an agency in Ohio that we were coding and billing for. We were making substantial changes to their codes and tried several times to educate the staff. They had Medicare patients that should have been Medicaid. When we reviewed and found these issues we warned them many times but they continued to keep things as is. They never accepted any of our coding or billing suggestions because it decreased the reimbursement. The were indicted on Medicare and Medicaid fraud and one of the owners is now serving time.

4. FORCE has worked for one customer for four years just as a fill in for vacations, holidays and over flow. They are comfortable that their coding will be maintained while their staff is not able to be there.

To redeem this coupon you should provide our coding department with two start of care and one re-cert patients. The coder will need the hospital H&P, the Oasis, the 485 and any other documentation that will support the coding efforts.

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